Significant Proportion Of Residents Research Articles

A Summary Prospecting of Possibilities of Providing Public Health Services at the Level of North-East Region of Romania

This paper investigates issues related to the public health system in the North-East Region of Romania, focusing on possibilities for addressing/improving specific deficiencies/difficulties. The concerned region is characterized by the highest and densest population in the country, with a significant proportion of residents in rural areas (55%) and a high level of poverty. Population health indicators are among the weakest nationally, and the healthcare infrastructure is inadequate for the population's needs, with an uneven distribution that generates significant inequalities in access to medical services in the respective counties. Starting from the (statistical) certainty that Romania ranks among EU member states with the highest avoidable mortality, the paper addresses both preventable causes through public health interventions and treatable causes through quality care. After a brief introduction, the overall state of the public health system in Romania is examined, followed by a detailed analysis of the main issue stated in the title, highlighting multiple critical aspects based on data and information from official reports of prestigious institutions. Special attention is given to specific issues in local communities related to healthcare infrastructure and the provision of medical services, as well as possible solutions offered through the implementation of the General Regional Health Services Plan 2021-2027 in the North-East Region. The paper concludes with a section of conclusions, which includes perspectives on the future development of the analyzed sector.

Assessing Telemedicine Knowledge and Utilization among Residents in Benin City, Edo State during the COVID-19 Pandemic: A Descriptive Study

Background: The COVID-19 pandemic has accelerated the adoption of telemedicine, addressing healthcare service gaps. This study  aimed to evaluate the knowledge and utilization of telemedicine among residents in Benin City, Edo State, Nigeria.
 Methods: A descriptive cross-sectional survey was conducted among adult residents of Benin City. A multi-staged sampling technique  comprising four stages was employed to select respondents, and data were collected through a pre-tested self-administered  questionnaire. Statistical analysis was carried out using IBM SPSS vs 25.0. Significance was established at p < 0.05, and results were  presented as prose and frequency tables.
 Results: The study included 413 participants with a mean age (SD) of 26.9 ± 7.1 years. The  majority, 279 (67.6%), were students, and 289 (70.0%) had tertiary education. Good knowledge of telemedicine was demonstrated by 192  (61.5%) of the respondents but 122 (39.1%) had used telemedicine services. Fifty-seven (46.7%) of those who used telemedicine favoured  phone calls as the primary medium, citing its accessibility. Notably, 106 (86.9%) reported using telemedicine to reduce hospital waiting  times, and 105 (86.1%) appreciated its ready availability. Barriers to telemedicine use included network challenges during consultations  (42.6%) and inconsistent power supply (36.3%). Age (p = 0.045), sex (p = 0.038) and higher education (p = 0.009) were significantly  associated with better telemedicine knowledge.
 Conclusion: The study revealed that while a significant proportion of residents in Benin  City possessed good knowledge of telemedicine, its utilization remains low. Addressing infrastructure limitations and extending   educational efforts will be pivotal in bridging the knowledge-utilization gap in telemedicine.

Effect of Balint seminars training on emotional intelligence and burnout among internal medicine residents

Background: Balint seminars are widely used educational activities in family medicine residency programs. However, their impact on measurable outcomes is uneven and controversial. The discussions in Balint seminars deal with perceiving and understanding the emotions of the participants. Objective: This study measures the effect of Balint seminars on the emotional intelligence (EI) and burnout of internal medicine residents at the American University of Beirut. Design: Quasi-experimental observational pretest–posttest study. Setting: In all, 27 internal medicine residents at the American University of Beirut. Methods: Bi-weekly Balint seminars were delivered to internal medicine residents throughout the academic year. EI using Mayer Salovey and Caruso Emotional Intelligence Test (MSCEIT) and burnout level using Maslach Burnout Inventory (MBI) were measured at the beginning and end of the academic year. Results: A total of 20 Balint seminars were delivered. On average, residents attended six sessions with standard deviation ( SD) of 2. Using paired t-tests to compare post- and pre-total EI scores, there was no significant difference between the two scores (mean difference post-pre = -0.6 ± 9.7, p = .738). Gender was the most important predictor of the difference between pre- and post-total EI scores (women are the reference, β = -8.403, p = .007) as compared to understanding emotions baseline score (β = -0.263, p = .003). A significant proportion of residents (22.2%–29.6%) showed severe burnout levels on at least one of the three domains of burnout at baseline; however, Balint seminars did not have any effect on any of the burnout domains. Conclusions: Balint seminars may have the beneficial effect of improving emotional intelligence among women. Balint seminars did not improve the burnout levels of internal medicine residents. Optimizing attendance of the Balint sessions may affect the outcomes attributable to Balint seminars.

Managing conflicts between local land use and the protection of the Ethiopian wolf: Residents’ preferences for conservation program design features

Conflict over land use is one of the challenges faced by large carnivore conservation programs in human-disturbed landscapes. Designing effective conservation strategies requires an understanding of the socioecological context and people’s preferences towards conservation programs. This study investigates preferences of rural residents for management options defined by conservation program attributes to protect the endangered Ethiopian wolf, Canis simensis, in the Bale Mountains National Park of Ethiopia. The conservation program attributes examined include population targets for the Ethiopian wolf, increases in the size of the protected habitat area, monitoring outposts, local participation in monitoring, and provision of financial incentives to the local residents. Using a scale extended latent class model, we analyse choice experiment data collected from households living inside, adjacent to and outside the park. We find that preferences for the conservation programs are heterogeneous. Proximity to the park and park associated livelihoods influence residents’ preference for the conservation programs. A significant proportion of residents, predominantly agro-pastoralists, prefer increases in the population of the Ethiopian wolf and receiving financial incentives from wolf-related tourism. Addressing local livelihood interests, and promoting alternative livestock management strategies among rural residents, would help ensure tolerance to and the recovery of the wolf population.

Critical Deficiency Ratings in Milestone Assessment: A Review and Case Study.

The Accreditation Council for Graduate Medical Education (ACGME) requires programs to report learner progress using specialty-specific milestones. It is unclear how milestones can best identify critical deficiencies (CDs) in trainee performance. Specialties developed milestones independently of one another; not every specialty included CDs within milestones ratings. This study examined the proportion of ACGME milestone sets that include CD ratings, and describes one residency program's experiences using CD ratings in assessment. The authors reviewed ACGME milestones for all 99 specialties in November 2015, determining which rating scales contained CDs. The authors also reviewed three years of data (July 2012-June 2015) from the University of Cincinnati Medical Center (UCMC) internal medicine residency assessment system based on observable practice activities mapped to ACGME milestones. Data were analyzed by postgraduate year, assessor type, rotation, academic year, and core competency. The Mantel-Haenszel chi-square test was used to test for changes over time. Specialties demonstrated heterogeneity in accounting for CDs in ACGME milestones, with 22% (22/99) of specialties having no language describing CDs in milestones assessment. Thirty-three percent (63/189) of UCMC internal medicine residents received at least one CD rating, with CDs accounting for 0.18% (668/364,728) of all assessment ratings. The authors identified CDs across multiple core competencies and rotations. Despite some specialties not accounting for CDs in milestone assessment, UCMC's experience demonstrates that a significant proportion of residents may be rated as having a CD during training. Identification of CDs may allow programs to develop remediation and improvement plans.

Residents’ perceptions and valuations of urban wastelands are influenced by vegetation structure

Among the different urban green spaces, wastelands are valuable spaces for conserving urban biodiversity. By hosting wild and spontaneous vegetation, wastelands can promote the contact citizens have with nature. However, lack of regular management can lead to negative perceptions. In this study we assessed perceptions, valuations and uses of wastelands by residents in two cities in the centre of France. We tested whether preferences for wastelands depended on where wastelands were located in the city, plant community characteristics or resident characteristics. The study investigated 18 wastelands, in three successional stages (initial grassland, intermediate grassland and shrubbery stages) and located in three categories of distance from the city centre (downtown, suburban, periurban). Vegetation was sampled in each wasteland and several plant community metrics were calculated. A total of 72 residents (4 per wasteland) living in the vicinity of the wastelands were interviewed about their use, valuations and perceptions of wastelands. Based on qualitative and quantitative analyses, the results highlighted that a significant proportion of residents (36%) conducted various activities in wastelands and that perceptions and valuations of wastelands were diverse, ranging from either negative (when wastelands were perceived as wild or abandoned areas) or positive (when wastelands were considered as natural and recreational). Valuations strongly depended on the successional stage, with intermediate grassland-like wastelands being preferred. We found no effect of wasteland location in the city, whereas resident characteristics (age and gender) marginally influenced valuations. This study provides new insights into the determinants of perception and valuations of urban wastelands. Particularly, we suggest that intermediate grassland-like wastelands could be easily integrated into urban planning both for recreational activities and conserving biodiversity. Alternatively, awareness of the value of initial grassland-like and shrubbery wastelands should be raised to improve their acceptability.

Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents

ObjectiveThe study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. DesignThis was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. SettingA 300-bed long-term care hospital in Hong Kong. ParticipantsAll long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. MeasurementsInformation on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. ResultsThree hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7). ConclusionsSevere spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.

The potential, impacts and challenges of Pay-As-You-Throw for municipal solid waste services in Ghana

Objective: This study was undertaken to examine the potential of pay-as-you-throw (PAYT) as a cost recovery mechanism, its impacts on solid waste collection services and the challenges associated with its implementation in the Kumasi Metropolis, Ghana. Materials and Methods: Data were collected by weighing 262 head-loads of solid waste at communal container sites and recording their corresponding user charges in 14 low and middleincome communities in Kumasi. A household survey involving 80 randomly selected households patronizing communal disposal systems was undertaken to assess their perceptions of PAYT. In-depth interviews with heads of six private solid waste management companies and one with the Waste Management Department of the local authority were also conducted. Results: The study showed that the average revenue generated per ton of waste disposed into communal containers was GH¢ 17.07 (US$11.38). This is 70% higher than the collection fee paid to private waste management companies prior to the implementation of the PAYT. Each communal container accrues an average revenue of GH¢ 153 (≈US$103) when filled to capacity. However, a significant proportion of residents (80%) claimed not to have been informed about the PAYT mechanism prior to its implementation. Although PAYT has improved service levels due to regular pickup of communal containers, it is confronted with challenges including, inequitable user charges, illegal dumping of waste into communal containers at night; non-payment of user charges; and indiscriminate dumping of waste at unapproved locations. Conclusion: PAYT approach has the potential to ensure cost recovery and should be sustained. The local authority need to ensure equitable user charges; allocate buy-back points; undertake intensive public education on the PAYT; and monitor private waste management companies against exorbitant user charges.

Systems-Based Aspects in the Training of IMG or Previously Trained Residents: Comparison of Psychiatry Residency Training in the United States, Canada, the United Kingdom, India, and Nigeria

International medical graduates (IMGs) account for a significant proportion of residents in psychiatric training in the United States. Many IMGs may have previously completed psychiatry residency training in other countries. Their experiences may improve our system. Authors compared and contrasted psychiatry residency training in the U.S. to that of Canada, the United Kingdom, India, and Nigeria. The study also highlights the systems-based features that may have an impact on the adaptation of IMGs (especially previously-trained) to U.S. psychiatry residency. Individuals who are familiar with psychiatry residency training in the United States and were previously trained in other countries synthesized information available on websites, official documents, and previous literature, as well as their experiences with past training. Psychiatry residencies vary considerably in all five countries in terms of the duration of training, curriculum, clinical experience, psychotherapy training, research experience, supervision, and evaluation processes. Residency training in the U.S., Canada, and the U.K. is well-structured and has more psychotherapy training. The U.K. has enhanced exposure to community psychiatry. The U.K., India, and Nigeria have increased emphasis on psychopathology. Training in India and Nigeria has a higher quantity of clinical work, less record-keeping, less emphasis on patient autonomy, and a mandatory prospective clinical research requirement. The provision of services and training is substantially influenced by national mental health policies, culture, and local traditions. Despite numerous commonalities, there are some differences in psychiatry training among all five countries. Awareness of these differences in education, systems, and interactions may help psychiatric educators to understand IMGs (especially those previously-trained) as they adapt to U.S. training.

Residential care in the community for adults with intellectual disability: needs, characteristics and services.

The pattern of residential services for people with intellectual disability in England has changed dramatically since 1971, with many more places being made available in residential homes in the community. The aim of the present study was to assess the needs and characteristics of residents and features of all the residential homes provided by a national charity. Assessments of adaptive behaviour, problem behaviour and social impairment were completed by staff who knew residents well; information about costs and staffing was provided from central records. A significant proportion of residents have important care needs relating to their skills, their behaviour and their social abilities. Residents with these needs are dispersed throughout services, so that a large majority of services include one or more residents with relatively complex needs. Compared with services in the late 1980s, these services care for a much more disabled client group. Since individuals with high levels of particular needs are typically distributed throughout services, a very high proportion of services require staff who have relatively advanced skills. Current national plans do not adequately address this need and case management arrangements may encourage the re-creation of more institutional services. The first author is a Trustee of the charity.

Agitation in nursing home residents: the role of gender and social context.

We investigated the relationship among gender of resident, staff social interaction, and agitation in 46 (31 male and 15 female) nursing home residents with clinically significant agitation. Direct observations were conducted of resident behaviors and environmental contextual events using a computer-assisted, real-time observational system. The system recorded frequency, duration, and temporal sequencing of events. Results show that female residents displayed almost three times the amount of agitation as male residents (35% vs. 13% of total observation time, respectively), although men in the study were more likely to receive psychoactive drugs for their agitation. Staff spent similar amounts of time verbally interacting and touching male and female residents. Sequential analyses were conducted to examine the likelihood of staff verbal and touch interactions both preceding and following resident agitation using Bakeman and Quera's (1995) SDIS-GSEQ program. Results suggest that staff touch and verbal interaction elicit agitation in a significant proportion of residents. Once agitation occurs, staff were likely to respond by interacting verbally, but not physically, with the resident.

Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems?

There is a lack of prognostic data regarding tube feeding of institutionalized elderly people. The objective of this study was to determine the impact of feeding tubes on the survival of nursing home residents with chewing and swallowing problems, and to follow the course of the tube-fed residents over one year. We conducted a cohort study with 12-month follow-up using Minimum Data Set resident assessments from 1991. Participants included 5,266 nursing home residents over the age of 65 with chewing and swallowing problems living in 272 Washington state nursing homes. Residents who had a feeding tube were identified. Baseline clinical characteristics and 12-month survival were compared for residents with and without feeding tubes. The proportion of tube-fed residents who became tube-free during the follow-up period was determined, and clinical features that predicted this outcome were examined. Among the residents with chewing and swallowing problems, 10.5% had a feeding tube. After adjusting for potential confounding covariates, tube-fed residents had a significantly higher one-year mortality rate than those without feeding tubes (risk ratio, 1.44; 95% CI, 1.17-1.76). Of the 430 residents with feeding tubes who survived the follow-up period, 25.1% became free of a feeding tube. Age less than 87 years was associated with a significantly greater likelihood of becoming tube-free (odds ratio, 1.66; 95% CI, 1.03-2.6). Residents selected for feeding tube placement have poorer survival after one year than residents who are not tube-fed. However, the feeding tubes are removed in a significant proportion of residents who survive one year. Residents with a potentially reversible condition, for whom the feeding tubes are a temporary intervention, need to be identified.

Urban tenants and community involvement

One reason that community involvement in local improvement projects does not work is because this activity is based on the assumption that local residents are owners of their housing. In a growing number of cities, a very significant proportion of residents are no more than the renters of the property they occupy. The number of renters is growing largely because they are part of a group which cannot afford the cost of house purchase due to their poverty. Much urban development policy ignores this important fact and, as a result, improvements through upgrading do not occur. Based particularly on evidence from East Africa, but from other countries as well, the paper concludes that there is an urgent need to develop new approaches to the human settlement situation. These must include a wider approach to the various options of tenure, the development of community organisations dealing with a broader set of issues than just housing, the training of technicians and social workers to help organise improvements and the establishment of legal frameworks.

Influenza and pneumococcal vaccination in long term care facilities in two regions of Quebec.

To evaluate the use of influenza and pneumococcal vaccines in long term care facilities. Cross-sectional survey in a random sample of 30 facilities in two regions of Quebec. Information was collected from the general manager or the chief of nursing, all consultant physicians and a random sample of 20 residents in each facility. Twenty-nine centres agreed to participate. The mean influenza vaccination rate was 70%, and was not influenced by differences in the types of facilities or the organization of the programs for immunization. The main obstacle to influenza vaccination reported by physicians was nonacceptance by a significant proportion of residents. Of the residents who did not initially request influenza vaccine, only 64% accepted vaccination when it was offered. The vast majority of residents were satisfied with the information they had received and the respect shown for their freedom of choice. Forty per cent of residents were unfit to provide a valid consent and the vaccination rate was 76% in this group. Only one-third of the physicians regularly obtained authorization from a relative or the legal guardian before prescribing vaccination for incompetent residents. None of the facilities studied had an effective program for pneumococcal vaccination, only 43% of the physicians reported any use of pneumococcal vaccine and 98% of residents had never heard of the vaccine. The national objective of 95% coverage with influenza vaccine will be difficult to achieve in long term care facilities, mainly because a minority of residents are not likely to be convinced of the benefit of immunization. Much remains to be done to promote and administer pneumococcal vaccine in this setting.